ASH 2022: KRd - An Effective Induction Therapy for High-Risk Newly Diagnosed Multiple Myeloma Patients

At the recent annual meeting of the American Society of Hematology, Dr. Carlyn Tan presented the results of a study from the Memorial Sloan Kettering Cancer Center showing that induction therapy with Kyprolis, Revlimid, and dexamethasone in patients with high-risk newly diagnosed multiple myeloma (HR-NDMM) led to better outcomes when compared to induction with Velcade, Revlimid and dexamethasone.

Improving Outcomes for Patients

While outcomes for myeloma patients have improved in the past years due to new treatments, prognosis remains suboptimal for patients with high-risk newly diagnosed multiple myeloma (HR-NDMM). Additionally, these patients are underrepresented in clinical trials, leading to variability in the recommendations for the management of these patients.

Nevertheless, achieving and maintaining MRD negativity appears to be a fundamental goal for improved survival outcomes in high-risk newly diagnosed myeloma, which is why this study of KRd vs. VRd induction compared the treatment responses and the rates of MRD negativity in each group.

KRd vs. VRd 

The ENDURANCE trial had already compared KRd vs. VRd as induction therapy, and their results did not find any difference between these lines of treatment. However, the ENDURANCE trial excluded patients with HR-NDMM and only included patients with no intention for immediate stem cell transplant, which is why the Memorial Sloan Kettering Cancer Center decided to examine outcomes associated with KRd and VRd induction and include patients with:

• High-Risk Newly Diagnosed Multiple Myeloma, and
• Patients who received stem cell transplant as part of frontline treatment

In this study, a retrospective chart review was conducted with 154 HR-NDMM patients treated with KRd and VRd at Memorial Sloan Kettering. The primary endpoint was progression free survival (PFS).

As you can see in the image below, the median Progression Free Survival was 70.9 months in the KRd group and 41 months in the VRd group.

Secondary endpoints were:

• Overall response rate
• MRD negativity rate
• Event Free Survival
• Overall Survival

As you can see in the image below, 40% of the patients who had induction therapy with KRd achieved Complete Response at the end of induction, compared to only 25% of patients on the VRd group.

Additionally, 29% of patients from the KRd group achieved MRD negativity compared to 21% from the VRd group.
 

This study concluded that induction therapy with Kyprolis, Revlimid, and dexamethasone in patients with high-risk newly diagnosed multiple myeloma was associated with a deeper response and improved Progression Free Survival compared to induction with Velcade, Revlimid, and dexamethasone.